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Why Casinos Matter Institute for American Values A Report from the Council on Casinos Thirty-One Evidence-Based Propositions from the Health and Social Sciences

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Why Casinos Matter

Institute for American Values

A Report from the Council on Casinos

Thirty-One Evidence-BasedPropositions from the Health andSocial Sciences

About this Report

THIS REPORT COMES FROM THE COUNCIL ON CASINOS, an independ-

ent, nonpartisan group of scholars and leaders who come

together to examine the role of casinos in American life and

to foster informed citizen debate on gambling as a public policy.

Financial support for this initiative comes from the Bodman Foundation,

the John Templeton Foundation, and other contributors to the Institute

for American Values.

© 2013, Institute for American Values. No reproduction of the materials contained here-

in is permitted without the written permission of the Institute for American Values.

ISBN: 978-1-931764-44-45

Ebook ISBN: 978-1-931764-45-2

Institute for American Values

1841 Broadway, Suite 211

New York, NY 10023

Tel: (212) 246-3942

Fax: (212) 541-6665

Website: www.americanvalues.org

Email: [email protected]

Table of Contents

Members of the Council on Casinos.......................................................

Introduction.............................................................................................

The Thirty-One Propositions: A Snapshot..............................................

The Thirty-One Propositions..................................................................

Conclusion...............................................................................................

Appendix: How Much Gambling Revenue Comes from Problem Gamblers?.................................................................................

Sources....................................................................................................

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JAY BELSKY

University of California, DavisDavis, CA

JEFFREY BENEDICT

Southern Virginia UniversityBuena Vista, VA

DAVID BLANKENHORN

Institute for American Values New York, NY

MARK BOYD

Goodwill Industries ofSouthern New Jersey andPhiladelphia Maple Shade, NJ

HANS C. BREITER

NorthwesternUniversityFeinberg School of Medicine Chicago, ILMassachusetts General HospitalBoston, MA

JONATHAN CONNING

Hunter CollegeThe Graduate Center, CUNYNew York, NY

RICHARD A. DAYNARD

Northeastern UniversitySchool of Law Public Health AdvocacyInstituteBoston, MA

JOHN J. DIIULIO, JR.University of Pennsylvania Philadelphia, PA

WILLIAM J. DOHERTY

University of MinnesotaSt. Paul, MN

ROBERT FRANK

Cornell UniversityJohnson Graduate Schoolof Management Ithaca, NY

WILLIAM A. GALSTON

Brookings Institution Washington, DC

CLAIRE GAUDIANI

New York UniversityThe Declaration Initiative New York, NY

NEIL GILBERT

University of California,BerkeleyBerkeley, CA

ROBERT GOODMAN

Hampshire CollegeAmherst, MA

EARL GRINOLS

Baylor UniversityHankamer School of Business Waco, TX

Members of the Council on Casinos

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JONATHAN HAIDT

New York UniversityStern School of Business New York, NY

WILLIAM A. JOHNSON, JR.Rochester Institute ofTechnologyFormer Mayor of Rochester Rochester, NY

JOHN KINDT

University of IllinoisCollege of Business Champaign, IL

KATHLEEN KOVNER KLINE

University of PennsylvaniaSchool of MedicineThe Consortium Mental HealthCenter Philadelphia, PA

RICHARD C. LEONE

The Century FoundationNew York, NY

GLENN C. LOURY

Brown University Providence, RI

STEVEN MALANGA

Manhattan Institute New York, NY

LAWRENCE M. MEAD

New York University New York, NY

DAVID G. MYERS

Hope CollegeHolland, MI

STEPHEN G. POST

Stony Brook University Department of PreventativeMedicine Stony Brook, NY

R.R. RENO

First ThingsNew York, NY

FRED SIEGEL

Saint Francis CollegeManhattan Institute Brooklyn, NY

MARGARET O'BRIEN STEINFELS

Commonweal Fordham Center on Religionand Culture New York, NY

CHARLES WHEELAN

Dartmouth CollegeRockefeller Center for PublicPolicyHanover, NH

BARBARA DAFOE WHITEHEAD

Institute for American Values New York, NY

AJUME H. WINGO

University of Colorado Boulder, CO

ALAN WOLFE

Boston College Boston, MA

PETER WOOD

National Association ofScholarsNew York, NY

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From time to time in American history, a new institution takes rootacross the country, and in doing so, changes the nation—changes thephysical landscape of communities, impacts the patterns and habits ofdaily life, affects citizens’ and communities’ economic outcomes, and insome cases even alters relationships between the governing and thegoverned, the more privileged and the less privileged.

Consider the sudden emergence and rapid expansion of fast foodchains in the mid-20th century. At one point, a fast food establishmentcoming to your town was a rare event. Only a few years later, it wascommonplace. A major new institution had taken root across the nation,and the way we eat—and the size of our waistlines—changed as aresult.

Or take the more recent rise of payday lenders. Several decades ago,these businesses were illegal loan-sharking operations. Today, in sub-urban strip malls and shopping centers, thousands of legal paydaylenders offer high-interest loans to people in need of fast cash. Quitesuddenly, these lending establishments have become part of the finan-cial landscape.

Something of this magnitude—an institutional eruption of similar sizeand consequence—is now occurring in the United States. It is thespread of casinos. For most of our history, casinos were illegal. From1930 through the late 1980s, they were legal only in the desert cities ofNevada and (since 1977) the beach town of Atlantic City.

But starting in about 1990, something new and important began to hap-pen. Casinos began to enter the mainstream of American society. Nolonger viewed by government as a dangerous vice, and no longer cor-doned off and geographically removed from the everyday ebb and flow

Why Casinos MatterThirty-One Evidence-Based Propositions fromthe Health and Social Sciences

Introduction

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of American life, casinos are now popping up across the nation, near ashopping mall or a river dock near you, with the full support and spon-sorship of the very state governments that only yesterday had outlawedthem.

Nearly a decade and a half ago, in the early stages of the casino ascen-dancy, the federally funded National Gambling Impact Study Commissionconcluded its multi-year investigation of gambling in America with a callfor a moratorium on further expansion. That recommendation wentunheeded. Instead, states rushed headlong into legalizing new casinoswithin their borders.

Moreover, during this period of expansion, casino gambling itself haschanged dramatically. A national market headquartered in Nevada andAtlantic City has been joined by dozens of new regional markets acrossthe country. Table games catering to high rollers have largely given wayto slot machines catering to middle and low rollers. Casino gambling as aonce or twice a year vacation has largely given way to casino gambling asa once or twice a month or once or twice or more a week pattern of life.

Whether or not you personally gamble in them, the new casinos matter.They are influencing the nation as a whole. They are affecting our health,our economics, our politics, our ideas and social values, and perhapseven our sense of who we are as a people and what obligations we havetoward one another. They appear to be connected in important ways tothe rise of American inequality. And because these changes are of recentorigin and are still unfolding, they tend to be only partially and oftenpoorly understood by the general public, journalists in the print andbroadcast media, policy makers, and civic and business leaders—espe-cially those who have never themselves visited one of the new casinos.

We offer thirty-one propositions, based on the best available evidencefrom the health and social sciences, to describe how casino gambling ischanging and how this new social and institutional form is changingAmerican life.

A Note on Sources: In Great Britain and in provinces of Canada andAustralia, governmental leaders have commissioned comprehensive,

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well-funded research and policy studies of casino gambling. This hasnot happened in the United States. In the U.S., the leading funder ofgambling research is the gambling industry itself.

For the evidentiary basis of this report, we have relied primarily onindependent research, by which we mean research that was not fund-ed or controlled by the gambling industry. For the future, we recom-mend that U.S. federal and state governments help to establish a nonpartisan research agenda supported by independent funding aimedat the further study of state-sponsored and Internet gambling.

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The Thirty-One Propositions: A Snapshot

Casino gambling has moved from the margins to the mainstreamof American life.

Today’s regional casinos are different from Vegas-style resortcasinos.

The Rise of the New American Casino

The new American casino is primarily a facility filled with modernslot machines.

A modern slot machine is a sophisticated computer, engineered tocreate fast, continuous, and repeat betting.

Modern slot machines are carefully designed to ensure that thelonger you play, the more you lose.

Modern slot machines are highly addictive.

Modern slot machines are engineered to make players lose trackof time and money.

The Casino’s Modern Slot Machines

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Casinos depend on problem gamblers for their revenue base.

Living close to a casino increases the chance of becoming aproblem gambler.

Problem gambling is more widespread than many casinoindustry leaders claim.

Problem gambling affects families and communities as well asindividuals.

Young people are viewed as the future of casino gambling.

Working in a casino appears to increase workers’ chances ofhaving gambling problems.

Working in a casino appears to increase workers’ chances ofhaving health problems.

The Casino’s Health Impact

The benefits of casinos are short-term and easy to measure whilemany of their costs are longer-term and harder to measure.

Casinos extract wealth from communities.

Casinos typically weaken nearby businesses.

Casinos typically hurt property values in host communities.

The Casino’s Economic Impact

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Casinos are the creation of state government and its publicpolicies.

State regulation of casinos creates a conflict of interest, in whichthe state is charged with protecting the public from the verybusiness practices that generate revenue for the state and whichthe state is co-sponsoring.

States are typically failing to protect their citizens from theharms of state-sponsored casino gambling.

States are typically failing to provide adequate help for the treat-ment of problem and compulsive gambling.

Some states are propping up failing casinos.

Over time, casino expansion within a state and in nearby statescan create a downward economic spiral of market saturation,sluggish state revenues, and failing casinos, marked by an ever-growing competition in which each state tries to lure otherstates’ citizens into its casinos.

Regional casinos are a regressive source of revenue for thestates.

The Casino’s Political Impact

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State sponsorship of casinos is a policy contributing to patternsof inequality in America.

State sponsorship of casinos raises troubling ethical questionsabout fairness and equal treatment of citizens.

The Casino’s Social Meaning

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Encouraging people to put their money into slot machines hashistorically been viewed as unethical.

Encouraging legal gambling as “fun” entertainment and an all-American pastime is a historically new development.

The Casino’s Historical Meaning

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Research on gambling in America is largely funded by the gam-bling industry.

Research on gambling funded by the gambling industry focus-es overwhelmingly on the individual pathology and pharma-cology of gambling addiction while avoiding research intomachine design, player profiling, and other industry practicesand technological innovations that foster gambling addiction.

The Casino’s Intellectual Impact

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The Rise of the New American Casino

Casino gambling has moved from the margins to themainstream of American life.

Within the lifetime of most Americans, legal casino gambling existed inonly two locations in the U.S: Nevada and Atlantic City, N.J. Beginningin the 1990s, casinos spread across the nation at an accelerating pace.Today, 23 states have commercial casinos, a category which includesland-based, riverboat, dockside, and racetrack casinos. In the Northeastand mid-Atlantic states, nearly every adult now lives within a short driveof a casino.

Today’s regional casinos are different from Vegas-styleresort casinos.

America’s new regional casinos may be called “resorts” by the gamblingindustry and “destination resorts” by the political leaders who sponsorthem, but they are actually quite different from the resort casinos his-torically located in Las Vegas, Macau, and other higher-end vacationlocales.

Classic destination resort casinos attract customers from across thenation and the globe. Their patrons usually travel long distances to getto the casino, arrive in rental cars, stay in hotels, and spend money onhigh-end restaurants, elegant shops, and concerts featuring world-classentertainers as well as on gambling.

By contrast, regional casinos attract the great majority of their customersfrom nearby communities, sometimes including nearby communitiesacross the borders of neighboring states. Their patrons typically traveldistances of 70 miles or less, arrive in their own cars or on buses, spendnearly all their time and money gambling at the casino, and returnhome to sleep in their own beds.

The Thirty-One Propositions

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A destination resort casino is a place you might visit once a year. Aregional casino is a place you might visit several times a month or sev-eral times a week.

The traditional Vegas-style resort casinos catered mainly to high rollersand “whales” partial to table games. Today’s regional casinos cater over-whelmingly to middle rollers and low rollers who play slot machines.

In short, unlike the old Vegas-style resorts, the new regional casinosdepend decisively on attracting gamblers who live in the region, whoreturn frequently, and who play modern slot machines.

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The Casino’s Modern Slot Machines

The new American casino is primarily a facility filled withmodern slot machines.

Slot machines have transformed American gambling. In 1978, outside ofNevada, there were virtually no legal slot machines in the United States.In 1991, there were about 184,000. By 2010, there were about 947,000,a more than five-fold increase in less than two decades.

Slot machines and other computerized gambling machines now occupynearly all of the space on the casino floor. Even traditional table gamesare likely to be run by a computer.

Slots are highly profitable. In 2013, the percentage of casinos’ total gam-bling revenue deriving from slot machines is estimated at 62 to 80 per-cent, with racinos (racetrack casinos) getting 90 percent of their takefrom slots. As Frank Farenkopf, the recently retired CEO of theAmerican Gaming Association puts it: “It’s the slot machine that drivesthe industry today.”

A modern slot machine is a sophisticated computer, engineered to create fast, continuous, and repeat betting.

Many people still think of slot machines as mechanical “one-armed ban-dits.” Players used to sit at these machines with a bucketful of coins; puta coin in a slot; pull a mechanical lever to activate a spin of a single reel;and wait for images of cherries or “7’s” to appear on a console screen.And then, they repeated the same motions again and again, waiting fora flood of nickels or quarters to pour out of the machine for a win.

Modern slot machines are entirely different. They are programmed forfast, continuous, and repeat betting. Players insert plastic, not coins;they tap buttons or touch a screen rather than pull levers; they placebets in denominations ranging from a penny to a hundred dollars onmultiple lines that spin across a screen with each rapid tap of the but-ton. An electronic counter on the console tallies credits for wins and

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losses. All of this happens at a blindingly fast speed. Even penny betson multiple lines with each spin can result in large losses.

Modern slots are hooked up to a central server that collects player infor-mation, preferences, and speed of play and has the capacity to programeach machine to each player’s style. In short, the laws of pure chanceor probability no longer dictate wins and losses. The modern slot expe-rience is deliberately engineered to take in much more than it pays out.

Modern slot machines are carefully designed to ensurethat the longer you play, the more you lose.

Slot machines are designed to get players to gamble longer and losemore over time, or, in the lingo of the trade, to boost REVPAC—revenueper available customer. According to MIT anthropologist Natasha Schull,who has done an exhaustive study of slot machine design, the trend inslot design is to provide a slow and smooth “ride,” with small wins thatare less than the amount bet, but nonetheless encourage repeat betsand prolonged “time on machine.” This experience is especially appeal-ing to low rollers. It gives them small rewards along the way and asense of winning but ensures that they gradually lose more than theyever win.

Modern slot machines are highly addictive.

Studies consistently find that people who play slots as their primaryform of gambling are more likely to become problem gamblers.According to one well-designed study, they are also likely to experiencemore rapid onset of gambling addiction than people who engage inmore traditional forms of gambling. Moreover, this study, which con-trolled for subjects’ personality traits, emotional problems, or substanceabuse, concluded that the machines themselves were responsible forthe gamblers’ addiction, not the gamblers’ personal traits or pre-existingconditions. In Australia, where machine gambling is endemic, a recentstudy by the government found that 16 percent of people who playweekly on the machines are problem gamblers while an additional 15

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percent are at moderate risk for a gambling problem. These findingsmay understate the full extent of harms from gambling machines. Nearlyhalf of individuals sitting in front of gambling devices at any one timeexhibit “problematic” gambling behaviors.

Modern slot machines are engineered to make playerslose track of time and money.

Modern slot machines are highly addictive because they get into peo-ple’s heads as well as their wallets. They engineer the psychologicalexperience of being in the “zone”—a trance-like state that numbs feel-ing and blots out time/space. For some heavy slot players, the goal isnot winning money. It’s staying in the zone. To maintain this intenselydesirable state, players prolong their time on the machine until they runout of money—a phenomenon that people in the industry call “playingto extinction.”

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The Casino’s Health Impact

Casinos depend on problem gamblers for their revenuebase.

Problem gamblers account for 40 to 60 percent of slot machine rev-enues, according to studies conducted over the past decade or so. Thisevidence contradicts claims by gambling lobbyists that their industrywants to attract only those customers who play casually “for fun.”Indeed, if casinos had to rely on such casual customers, they would notlong survive. A Canadian study found that casual players comprised 75percent of players but contributed only 4 percent of net gambling rev-enue. The casinos’ real money comes from problem gamblers. (For afull presentation of evidence, see the appendix, “How Much GamblingRevenue Comes from Problem Gamblers?”)

Living close to a casino increases the chance of becominga problem gambler.

Numerous studies show that living close to a casino is a key factor inmore frequent gambling. More frequent gambling increases the risk ofserious problem gambling. A large-scale study in 2004 found that peo-ple who live within 10 miles of a casino have twice the rate of patho-logical and problem gambling as those who do not. Another studyfound that the four counties in Nevada with the greatest access to casi-nos had the highest problem gambling rates while the four countieswith the least access had the lowest rate.

Similarly, a British study of casino gamblers found a strong associationbetween frequency of play and problem gambling. Frequent playerswere twice as likely to be diagnosed as problem or severe problemgamblers compared to those who played infrequently (14.8 percent offrequent players compared to 6.8 percent of infrequent players).

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Problem gambling is more widespread than many casinoindustry leaders claim.

Problem gambling is a technical term used for moderate and severegambling behavior. It is based on criteria first developed by theAmerican Psychiatric Association in 1980 when the organization includ-ed severe or pathological gambling in its Diagnostic and StatisticalManual of Mental Disorders.

However, the nature and extent of problem gambling is far from a set-tled question. Estimates of problem gambling vary greatly depending onthe criteria used, the measuring instruments employed, and populationsstudied. Moreover, researchers disagree over where to draw the linebetween moderate and severe gambling problems and which of thetwenty different screening questionnaires offer the most reliable meas-ure of a gambling disorder.

What can be said with confidence is that the prevalence of problemgambling has increased significantly in the period of rapid casinoexpansion since 1993. In some states, the rate of problem gamblingrises three to four-fold after the initial adoption of a casino before lev-eling off at this higher level or declining modestly.

Yet the gambling industry minimizes the harm. It claims that problemgambling affects an insignificant one percent of the population and thatthis proportion remains the same even as more Americans have easyaccess to nearby gambling venues.

Many scholars have criticized the one percent figure as misleading. It isbased on a survey of the general adult population—a significant pro-portion of whom do not gamble at all. Moreover, it counts only the mostsevere form of problem gambling—typically people who exhibit threeor more clinical symptoms used in the scoring diagnosis of mentalhealth disorders. It excludes gamblers who have less severe gamblingproblems and people whose lives and livelihoods may be adverselyaffected by their gambling but who do not meet any of the criteria of amental health diagnosis.

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A better measure is the percentage of problem gamblers among onlythose who actually gamble. Still better is the percentage of problemgamblers among people who gamble frequently. Estimates of the per-centage of frequent gamblers who are also problem gamblers rangefrom fifteen to twenty percent. Among frequent gamblers who betexclusively on slots, video lottery terminals, and other continuous elec-tronic gambling machines, rates of problem gambling can be even higher.Lastly, one might want to look at specific vulnerable subpopulations,such as Asian-Americans and the elderly, who are catered to by thegambling industry and are at high risk for gambling problems.

Problem gambling affects families and communities aswell as individuals.

Clinical and other observational studies confirm what common sensetells us: problem gamblers hurt their families as well as themselves. Thecompulsion to gamble leads to financial hardships: burdensome debt,loan defaults, and fraud; excessive payday borrowing; bankruptcy; lossof a business or home; and sometimes total destitution. Gamblingdestroys bonds of trust. Problem gamblers hide and lie about their gam-bling debts. They borrow or steal from family members, including chil-dren. They spend their time at the casino rather than at home.

Spouses are harassed by bill collectors and suffer a wide range of stress-related physical and mental problems; they attempt suicide at threetimes the rate of the general population. Women in such situations areat higher risk for domestic violence. A study of members of GamblersAnonymous found that upwards of 26 percent have gambling-relateddivorces or separations.

The harms to children are persistent and wide-ranging. They includefinancial insecurity, parental neglect, and pervasive feelings of aban-donment. Some children have spent hours alone in parked cars or unat-tended at home while their parents gamble in the casino. Others havelost money, homes, holidays, and the chance to go to college, due toparents’ gambling problems.

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It is especially worrisome that more women, typically the primary care-givers, are joining the ranks of slots gamblers.

Young people are viewed as the future of casino gam-bling.

A recent American Gaming Association survey of casino visitors ages 21-35 found that young people had the highest rate of casino visitation andthe greatest level of acceptance of casino gambling among all casinovisitors. Nearly 4 out of 10 (39 percent) had gone to a casino in the pastyear, and 9 out of 10 agreed that casino gambling was acceptable forthemselves and others. Machine gambling was ranked as the most pop-ular game among young adults. Frank Fahrenkopf of the AmericanGaming Association highlighted this news in a 2013 industry report,stating that young people are “the very people with whom the future ofour business lies.”

That future is not far off. More than any earlier generation, today’s youngpeople are technologically primed for gambling. From an early age, kidslearn to play games by tapping buttons and tracking images on screens.They spend money with a swipe of a debit card. They play video games.They live on social media. For these reasons, young people are a softtarget for Internet gambling—the next frontier for legalized gambling.

The first national U.S. survey of gambling among adolescents andyoung adults found that gambling among youth is widespread. It esti-mates that three-quarters of a million young people ages 14-21 arealready problem gamblers.

Working in a casino appears to increase workers’ chancesof having gambling problems.

Casino workers are at increased risk for gambling problems comparedto service workers in non-gambling businesses. One study of casinoworkers in Mississippi found that over half of the subjects reported pres-ent or past problems with gambling addiction.

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In New Jersey, eight percent of calls to the gambling help hotline camefrom casino employees, according to testimony by Sheila Wexler, thenExecutive Director of the Council on Compulsive Gambling in the state.“The problem exists at all levels of employment” she said and includesbehavior such as erratic work performance, borrowing money from co-workers or customers, absenteeism, tardiness, theft, embezzlement, andhealth problems.

Working in a casino appears to increase workers’ chancesof having health problems.

An American casino typically operates 24 hours a day, seven days aweek, 365 days a year. Its work force consists largely of shift workerswho serve food and drink, provide security, and clean the facility. Lifeas a shift worker in a casino poses a number of hazards to workers’health. To begin, there are physical and social disruptions. Shift worknegatively affects sleeping and eating patterns, dating and family rela-tionships, childcare, stress, and other health outcomes. Next there is thework environment itself. Like bartenders, casino workers are more like-ly to have problems with alcohol than other service workers. (Keep inmind that bars do not offer free alcohol, as many casinos do.) Smokingis permitted in many casinos, and workers are subject to the knownhealth risks of breathing secondhand smoke—a hazard now rare every-where except in casinos.

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The Casino’s Economic Impact

The benefits of casinos are short-term and easy to meas-ure while many of their costs are longer-term and harderto measure.

Impact studies measure short-term economic benefits of a prospectivecasino but they typically fail to measure longer-term social costs. Socialcosts tend to emerge over time and therefore are harder to quantify. Asa consequence, policy makers may overlook or underestimate the socialcosts of gambling.

For example: Evidence suggests that the opening of a new regional casi-no may offer an economic stimulus to distressed communities, but thestimulus fades over time, as the presence of a casino drives out estab-lished local businesses and attracts other gambling-linked businesses,such as payday lenders, pawn shops, auto title lenders, and check cash-ing stores.

Witness Atlantic City as a case in point. Casinos in Atlantic City beganas an economic renewal project, but after nearly four decades, the cityis still in need of economic renewal. Despite repeated bailouts by thestate and a recent $30 million state-funded marketing campaign, AtlanticCity remains an economically troubled place.

Atlantic City is not a unique case. A study that looked at the spread ofcasino gambling in 300 Metropolitan Statistical Areas found that thepresence of a casino reduces voluntarism, civic participation, family sta-bility, and other forms of social capital within 15 miles of a communitywhere it is located.

Likewise, problem gambling is hard to spot in the short-term. It takes along period of mounting financial and family troubles—estimated atfour to seven years—before a gambler admits to a problem. It takeseven longer for a problem gambler to feel desperate enough to seekhelp. And since most gamblers who seek help turn to GamblersAnonymous, a fellowship organization that does not provide statisticson its members, it is nearly impossible to get a complete picture of the

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total number of those who seek treatment. Finally, many problem gam-blers show up in other statistics—bankruptcy, unemployment, divorce,embezzlement, overindebtedness—where the causal relationship betweengambling problems and other problems is harder to establish.

That said, a 2004 study estimated the social costs of problem gamblingassociated with a new casino between $2,486 and $2,945 per problemgambler and $5,143 to $10,330 per additional pathological gambler (themost severe form of problem gambling). An earlier 1996 study of prob-lem gambling among members of Gamblers Anonymous looked atemployment-related social costs—working hours lost, unemploymentcompensation, and foregone income due to gambling—and found anannual cost of $2,836 per casino gambler, or $4,062 in 2013 dollars.

Casinos extract wealth from communities.

Regional casinos build their customer base by encouraging repeat visitsfrom local residents with incentives like “free” play and player loyaltyrewards. Repeat players spend dollars in a casino that would otherwisebe spent somewhere else in the local economy. Investor profits areextracted from the local market area, contributing to the long-term flowout of the community. Thus, the fundamental economic dynamic of aregional casino is taking dollars out of the community, not bringing dol-lars into the community.

Casinos typically weaken nearby businesses.

Casinos attract customers with “perks” such as free transportation, park-ing, food, and alcohol, not to mention the come-on of hitting the jack-pot and dreams come true. These realities make it harder for local busi-nesses to compete with casinos. Some eventually go out of business.

Consider what has happened in Atlantic City: Before 1977 there were242 eating and drinking establishments in Atlantic City. In 1981 (3 yearsafter casinos began operating, the number had declined to 160, and by1996 (19 years after casinos began operating) the number had declined

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to 142. A 2007 Federal Reserve study found that even after 20 years ofso-called economic development, there is still no large supermarket inthe city.

Casinos enjoy another competitive advantage over local businesses.They are given a regional monopoly by the state and gain special leg-islative exemptions from regulations imposed on non-casino businesses.In the Commonwealth of Massachusetts, for example, the state legisla-ture permits three newly authorized regional casinos to give free alco-hol to customers but bans local bars from offering heavily discountedalcoholic beverages for “happy hour” promotions. Other states allowsmoking in casinos but ban it in local restaurants and bars.

There appears to be at least one exception to the rule that casinos tendto weaken nearby businesses. Regional casinos do seem to promote theflourishing of nearby pawn shops, check-cashing operations, and high-interest lending establishments such as payday lenders. For example, arecent study of Mississippi Gulf Coast casinos reports: “All of the lawenforcement officials also noted that the number of pawn shops and‘check-cashing’ businesses on the Coast has exploded since the adventof gambling.”

Casinos typically hurt property values in host communities.

A recently released study by the National Association of Realtors saysthe impact of a prospective casino on the local housing market is“unambiguously negative.” The research conducted for realtors in west-ern Massachusetts, where a new regional casino is slated for construc-tion, found that homeowners in the host community would experiencefrom $1,650 to $3,300 in lost value. The study’s economists estimate thatthere will also be 125 additional home foreclosures each year, repre-senting $5 million in lost home values.

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The Casino’s Political Impact

Casinos are the creation of state government and itspublic policies.

Casinos are often described as public-private partnerships between gov-ernment and the gambling industry. (Kansas is an exception: its threecasinos are owned solely by the state.)

However, the new casinos cannot be viewed as just another kind ofpublic-private partnership. They are instituted by the states to create asource of revenue separate from direct taxation, the traditional way offinancing government expenses for the common welfare. States typical-ly legalize casino gambling by changing state constitutions. They createregional monopolies for the casinos. They regulate lightly and often inways that discriminate against other legal businesses. They promotecasino gambling through advertising and advocacy by public officials.They tell the public that casinos provide funds for necessary govern-ment services without raising taxes. They rescue casinos from bank-ruptcy. In short, without the legal, administrative, regulatory, and pro-motional advantages provided by state governments, casinos would notbe spreading into mainstream American life as they are today andwould likely still exist only on the fringes of the society.

State regulation of casinos creates a conflict of interest,in which the state is charged with protecting the publicfrom the very business practices that generate revenuefor the state and which the state is co-sponsoring.

State governments are caught in a classic conflict of interest betweentheir desire for more revenues and their responsibility to prevent harmsto the public from unfair or exploitative practices.

Many have resolved the conflict in favor of more revenues from casinos.This decision is a violation of the precautionary principle, which holdsthat government must engage in due diligence before introducing a pol-icy that might harm its citizens, even when the evidence of harm is not

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definitive. Yet in the case of casino gambling, there is clear evidence ofharm, and that fact alone is sufficient reason to require a moratorium onstate-sponsored gambling expansion. In fact, a moratorium was the mainrecommendation of the 1999 federally-funded report from the NationalGambling Impact Study Commission. But since that time, states haveraced ahead to locate commercial casinos in struggling communities andto extract revenues from citizens in those communities.

States are typically failing to protect their citizens fromthe harms of state-sponsored casino gambling.

Since the late 1990s, federal and state commissions have recommendedpolicies to protect citizens from the harms of state-sponsored casinogambling. These “best practices” policies are designed to hold the pro-ducers of gambling—the states and their partners in the gambling indus-try—responsible for its serious harms. However, few if any states haveactually adopted or implemented these “best practices.” They include:

Prohibiting gambling advertising, as is the case with cigarette adver-tising.

Modifying the machine design to reduce speed and duration of play.

Removing ATMs and credit facilities from the casinos.

Requiring breaks/cooling-off periods in machine play.

Prohibiting free alcohol on the casino floor.

Displaying onscreen clocks on the machines.

Prohibiting casino lending on credit.

Establishing an independently funded National Institute on ProblemGambling to conduct research and public education.

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States are typically failing to provide adequate help forthe treatment of problem and compulsive gambling.

Most state assistance is seriously underfunded (generally one-half toone percent of casino revenues) and mainly limited to directing peopleto self-help information: 1-800 numbers; contact information forGamblers Anonymous; and website addresses for state councils onproblem gambling. Except for Gam-Anon, a support group for familiesof compulsive gamblers, there are very few resources available for chil-dren, spouses, and other affected family members. State councilsreceive a significant share of their funding from state gambling revenuesand therefore are constrained from serving as independent advocatesfor more aggressive efforts to fund and treat gambling addiction, or toprevent the further spread of casinos in the first place.

Some states are propping up failing casinos.

Like big banks, state-sponsored casinos are not allowed to fail. Whencasinos come up short, states usually provide new infusions of money,reduced taxes, reduced funding for gambling addiction measures, orother concessions such as lifting smoking bans, in order to sustain rev-enues and profitability. Rhode Island, Delaware, and New Jersey haveall taken special steps to help casinos that might otherwise fail.

Over time, casino expansion within a state and in nearbystates can create a downward economic spiral of marketsaturation, sluggish state revenues, and failing casinos,marked by an ever-growing competition in which eachstate tries to lure other states’ citizens into its casinos.

New England and the mid-Atlantic states are already crowded with casi-nos. Nonetheless, they continue to wage casino border wars.Massachusetts has approved three new casinos and a slot parlor to com-pete against Connecticut’s two Indian casinos. Rhode Island is addingtable games to draw customers to Twin Rivers, a slot parlor just acrossthe border from Massachusetts. New Hampshire’s governor recently lost

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her fight to build a casino just over the Massachusetts border, but she isexpected to try again.

Meanwhile, New York, which straddles both New England and the mid-Atlantic states, is seeking to capture business across borders by legaliz-ing new regional casinos in upstate New York. If approved, the newcasinos will be added to the eight Indian casinos and nine racetrackcasinos already established in the state.

It’s a similar story in the mid-Atlantic states. Pennsylvania has twelvecasinos; Maryland has four; New Jersey’s Atlantic City has twelve; andtiny Delaware, struggling to compete with its three casinos, has justapproved Internet gambling. The competition is likely to get even morebrutal in the coming years. A new Baltimore-based casino is planned for2014 and there are tentative plans for casinos in Philadelphia andMaryland’s National Harbor area in 2016.

Casinos may begin by making lots of money for the state government,but the economic dynamics over time tend to become increasingly neg-ative and zero-sum, as politicians try to solve the problem of sagginggambling revenues by sponsoring more gambling, and as every statetries harder and harder to poach gamblers from other states.

Regional casinos are a regressive source of revenue forthe states.

Casino gambling was once a largely upper-class activity. As a classic1977 study argued, revenues from casino gambling came dispropor-tionately from well-off Americans who could travel long distances to aresort casino and gamble money they could afford to lose. At the sametime, however, the study’s author speculated that casino gamblingwould become more regressive as it became more widespread. That’sexactly what has happened.

With the spread of regional casinos into economically struggling com-munities, more working and middle class people are drawn to casinogambling. In the past, such residents may have gambled on the lottery,

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but few have had the time or money to travel to a far-away resort casi-no. With the arrival of a nearby casino, however, residents gain easyaccess to a gambling venue. Easy access increases local participationand drains dollars from local residents into the state’s coffers.

As a consequence, women, low-wage workers, and retirees are con-tributing a disproportionate share of states’ take of casino revenues. Asstates become ever more dependent on casino revenues as a substitutefor more progressive sources of revenue, they are trapped into a regres-sive policy of taking from the less affluent and rewarding the moreaffluent.

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The Casino’s Intellectual Impact

Research on gambling in America is largely funded by thegambling industry.

The American Gaming Association (AGA), the lobby for the gamblingindustry, created the National Center for Responsible Gaming (NCRG)in 1996 to provide industry-funded research on gambling addiction andto influence the findings of the federally funded National GamblingImpact Study Commission that was soon to begin its multiyear investi-gation.

Founding AGA president Frank Fahrenkopf made the strategic decisionto establish the industry’s own research arm after playing golf with aclose friend who had run the Tobacco Institute. As he tells it, “I hadseen the problems his industry had run into by denying the harmfuleffects of smoking. We knew that problem gambling was something wehad to handle, and it was the subject matter of our first board meeting.”

NCRG is now the largest and only private source of funding for science-based research on gambling and health in the U.S. over the past cen-tury. It is funding $950,000 in research grants in 2013, including multi-year funding for Centers of Excellence in Gambling Research at Yale,the University of Minnesota, and the University of Chicago. The indus-try funding devoted to research is, of course, a miniscule amount com-pared to the profits the industry rakes in.

Research on gambling funded by the gambling industryfocuses overwhelmingly on the individual pathology andpharmacology of gambling addiction while avoidingresearch into machine design, player profiling, and otherindustry practices and technological innovations that fos-ter gambling addiction.

The National Center for Responsible Gaming, the gambling industry’sresearch arm, states that it funds peer-reviewed, independent researchon gambling addiction. However, its research funding and agenda is

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largely devoted to scientific investigations into the biology of patholog-ical gambling, including its diagnosis and treatment. Of the 200 peer-reviewed studies it has funded, not a single one investigates the inter-play between gamblers and the gambling machines; the addictivenature of modern gambling machines; or the industry’s own researchinto designing more addictive machines.

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The Casino’s Social Meaning

State sponsorship of casinos is a policy contributing topatterns of inequality in America.

As gambling has spread into economically distressed communities, ithas drawn more Americans in the lower ranks of the income distribu-tion into its venues. Low-income workers, retirees, minorities, and thedisabled include disproportionately large shares of regional casinopatrons.

In this way, state-sponsored casino gambling creates a stratified patternthat parallels the separate and unequal life patterns in education, mar-riage, work, and play that increasingly divide America into haves andhave-nots. Those in the upper ranks of the income distribution rarely,if ever, make it a weekly habit to gamble at the local casino. Those inthe lower ranks of the income distribution often do. Those in the upperranks rarely, if ever, contribute a large share of their income to thestate’s take of casino revenues. Those in the lower ranks do.

State sponsorship of casinos raises troubling ethical ques-tions about fairness and equal treatment of citizens.

State sponsorship of casinos is one of the most successful bipartisanpublic policies in today’s politically polarized culture. Both Republicansand Democrats, red states and blue states, Mississippi andMassachusetts, have pursued and promoted casino gambling as a rev-enue-producing policy. Few have paused to ask questions about theethics of such a policy:

Does state-sponsored gambling serve the greater public good?

Does it help to reduce social and economic inequality?

Does it produce things of lasting value that we can all be proud of?

Does it support the idea, considered by many thinkers to be essential

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in a democracy, that what happens to us depends more on what wedo than on whether we are lucky?

Does it build our human, social, or moral capital?

Does it hurt people? Is it fair?

These are not simply narrow questions about the morality of gambling,as some say dismissively. These are broad and important questionsabout a major new American institution. We must consider these ques-tions seriously, because how we answer them will help determine thedegree to which we can build a just society and establish a trustworthyrelationship between the government and the governed.

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The Casino’s Historical Meaning

Encouraging people to put their money into slot machineshas historically been viewed as unethical.

The fundamental dishonesty inherent in slot machines is that, notwith-standing the casinos’ messages to the contrary, the machines are pro-grammed to guarantee that the casino wins. While some individualspins do pay off, no steady player has ever, or will ever, win money byplaying slot machines. The steady player’s loss is a mathematical cer-tainty. That’s why former New York City mayor Fiorello La Guardiacalled the machines “mechanical pickpockets” and distributedbrochures across the city entitled “You Can’t Win at the Slot MachineRacket.” Because you can’t.

Some people believe that operating slot machines has historically beenviewed as dishonest because it was illegal. That is partly true. But thelarger truth is that operating slot machines has historically been treatedas illegal because it is dishonest. Enticing people who may be vulnera-ble or unwary to lose their money by betting against a machine that hasbeen programmed in advance to take their money has not, in theAmerican experience, been generally viewed as an honest thing to do—an ethical problem that becomes even more serious when the govern-ment is actively involved in the enticing.

Encouraging legal gambling as “fun” entertainment and anall-American pastime is a historically new development.

The promotion of gambling as a “fun” entertainment choice hasemerged as the result of two converging forces: the states’ partnershipwith gambling interests to raise revenues that are not considered newtaxes; and the redefinition of excessive gambling as a mental disorderaffecting only a small percentage of the potential gambling population.

Throughout our history, gambling itself was regarded as a problem forthe entire society. It led to crime and corruption. It harmed families,finances, and reputations. It undermined middle class values of work,

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thrift, and deferred gratification. That’s why it was illegal almost every-where. But in 1980, in what was a watershed moment, gambling wasdefined in the Diagnostic and Statistical Manual of Mental Disorders ofthe American Psychiatric Association as a specific problem for thoseindividuals uniquely susceptible to its appeal.

This medicalization of society’s understanding of gambling has hadsocial, political, and public policy consequences that are both profoundand troubling. One consequence is that the new understanding purportsto divide the American public into two separate and unequal groups:on one side is the great majority of the population who can enjoy gam-bling as healthy fun; and on the other side is a small clinical populationthat fits the specific diagnostic criteria of gambling addiction.

A second consequence is that the gambling lobby has used the new def-inition of gambling to promote the idea that the harms of gambling arelimited and manageable and that the gambling industry itself – the pro-ducer of the harms—is also the best source of research and investiga-tion into limiting those harms.

A third consequence is that the redefinition of gambling exempts statesfrom their traditional public health responsibility to prevent the knownharms of gambling and, instead, allows government to shift responsi-bility for treatment onto the gambler herself and onto mental health pro-fessionals.

Conclusion

EVIDENCE FROM THE HEALTH AND SOCIAL SCIENCES suggests that thenew American casinos are associated with a range of negativehealth, economic, political, intellectual, and social outcomes. For

this reason, we view state sponsorship of casino gambling as a regres-sive and damaging policy.

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How Much Gambling Revenue Comes from ProblemGamblers?

Proponents of casino gambling often say that casinos provide enter-tainment for many Americans who enjoy occasional gambling. Theyalmost never say that a large proportion of casino revenue comes fromproblem and pathological gamblers.

Evidence from scholarly studies on the relationship between casinoincome and problem gambling consistently and robustly points to theconclusion that casinos disproportionately rely on problem and patho-logical gamblers for their revenue base.

Evidence from Direct Estimates

About 35 to 50 percent of casino revenues derive from problem andpathological gamblers.

Source: Earl L. Grinols and J.D. Omorov, “Development orDreamfield Delusions? Assessing Casino Gambling’s Costs andBenefits,” Journal of Law and Commerce 16, no. 1 (1996): 60.

About 33.1 to 55 percent of casino revenues derive from problemgamblers (Alberta: 37.2 percent; British Columbia: 33.1; Nova Scotia:48.7; Iowa: 38.4; New York: 41; Washington: 55).

Sources: Henry R. Lesieur, “Pathological and Problem Gambling:Costs and Social Policy,” Testimony before the Rhode Island HouseGambling Commission, October 15, 2002. Henry R. Lesieur, “Costsand Treatments of Pathological Gambling,” Annals of the AmericanAcademy of Political and Social Science 556, no. 153 (March 1998):165.

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About 37.3 percent of gambling expenditure was accounted for byresidents with gambling problems.

Source: Tremayne, Kell, Helen Masterman-Smith, and Jan McMillen,Survey of the Nature and Extent of Gambling and Problem Gamblingin the ACT (Sydney: University of Western Sydney, AustralianInstitute for Gambling Research, 2001), 10.

About 38.4 percent of gaming machine and casino table game rev-enue derives from problem gamblers.

Source: Australian Government Productivity Commission, Australia’sGambling Industries, Inquiry Report, no. 10 (Canberra: AustralianGovernment Productivity Commission, 1999), vol. 3: appendices,12,http://www.pc.gov.au/__data/assets/pdf_file/0006/82554/ gam-bling3.pdf.

About 47.5 percent of gaming machine and casino table game rev-enue derives from problem gamblers.

Source: Tremayne, Kell, Helen Masterman-Smith, and Jan McMillen,Survey of the Nature and Extent of Gambling and Problem Gamblingin the ACT (Sydney: University of Western Sydney, AustralianInstitute for Gambling Research, 2001), derived from p. 114, table 25.

Evidence from Relative Gambling Losses

About 50.2 percent of casino revenues derive from problem gamblers.

Australian problem players lose 17 times more than non-problemplayers. Nine percent of machine players are problem gamblers.Implies 62.7 percent of machine revenue is from problem gamblers..627*.8 = 50.2 percent. (The .8 multiplier in this note and notes 7–11derives from 80 percent of casino revenues coming from slotmachines.)

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Source: Henry R. Lesieur, “Pathological and Problem Gambling:Costs and Social Policy,” Testimony before the Rhode Island HouseGambling Commission, October 15, 2002.

About 54.2 percent of casino revenues derive from problem gamblers.

Nova Scotian problem players lose 16 times more than non-problemplayers. Sixteen percent of machine players are problem gamblers.Implies 67.8 percent of machine revenue is from problem gamblers..678*.8 = 54.2 percent.

Source: Henry R. Lesieur, “Pathological and Problem Gambling:Costs and Social Policy,” Testimony before the Rhode Island HouseGambling Commission, October 15, 2002.

Evidence from Gambling Machine Revenue Shares

About 33.8 percent of casino revenues derive from problem gamblers.

About 42.3 percent of EGM (electronic gaming machine) revenuecame from people with gambling problems.

Source: Australian Government Productivity Commission, Australia’sGambling Industries, Inquiry Report, no. 10 (Canberra: AustralianGovernment Productivity Commission, 1999); 0.8*.423 => 33.8 per-cent.

About 38.6 percent of casino revenues derive from problem gamblers.

About 48.2 percent of EGM revenue came from people with gam-bling problems.

Source: Tremayne, Kell, Helen Masterman-Smith, and Jan McMillen,Survey of the Nature and Extent of Gambling and Problem Gamblingin the ACT (Sydney: University of Western Sydney, AustralianInstitute for Gambling Research, 2001), 114; 0.8*.482 => 38.6 percent.

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About 48 percent of casino revenues derive from problem gamblers.

Given the variability associated with different sample sizes andmethods for calculating the shares, the combined risk categoryCPGI 3+ [Canadian Problem Gambling Index] probably gives a morereliable estimate of the relative spending of higher risk gamblers. Itranges from 42 to 74 percent [of total gaming machine spending],with an average of 60 percent.

Source: Australian Government Productivity Commission,Gambling: Productivity Committee Inquiry Report, no. 50 (Canberra:Australian Government Productivity Commission, 2010), vol. 2, app.B, B11,http://www.pc.gov.au/__data/assets/pdf_file/0003/95682/ gam-bling-report-volume2.pdf;0.6*.8 => 48 percent.

About 49.6 percent of casino revenues derive from problem gamblers.

About 62 percent of machine revenue is derived from problem gam-blers.

Source: Robert Williams and Robert Wood, The DemographicSources of Ontario Gaming Revenue, Final Report, prepared forOntario Problem Gambling Research Centre (Ontario: OntarioProblem Gambling Research Centre, 2004), 42, table 17, “Proportionof Revenue Derived from Problem Gamblers as a Function of Typeof Gambling”; 0.8*.62 => 49.6 percent.

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Sources

[Twenty-three] states have commercial casinos… American GamingAssociation, 2013 State of the States: The AGA Survey of CasinoEntertainment (Washington, DC: American Gaming Association, 2013),11. Journalist Sam Skolnick provides a synopsis of the efforts to expandgambling in thirty-seven states in 2009 and 2010 in High Stakes: TheRising Cost of America’s Gambling Addiction (Boston: Beacon Press,2011), 14–18. Not all were successful, but as Skolnick points out, therace to increase more gambling venues has accelerated in recent years.See also, “Gambling Developments in the States, 2010,” NationalConference of State Legislatures, accessed August 5, 2013,http://www.ncsl.org/issues-research/econ/gambling-developments-in-the-states-2010.aspx.

[W]ithin a short drive of a regional casino… For a map of the fifty-nineClass 3 casinos/racinos in the Northeast in 2013, see Clyde W. Barrow,“Are the New England States in a Gambling Arms Race?” (presentation,New England Fiscal Leaders Meeting, Federal Reserve Bank, Boston,MA, February 22, 2013),http://www.ncsl.org/documents/fiscal/NEFLM13Barrow.pdf.

[T]raditional resort destination casinos… Gambling researcher WilliamEadington coined the phrase “resort destination casino.” He describedthis kind of casino as a facility with three thousand or more hotelrooms, unique—often spectacular—architecture, extensive entertain-ment offerings, indoor and outdoor recreational options, extensiveculinary and shopping experiences, and, of course, “state of the art”gaming opportunities. Such casinos, he wrote in the late 1990s, can befound only in Nevada and Atlantic City, New Jersey. Today, Las Vegasremains the preeminent resort destination for national and internation-al visitors. According to its Convention and Visitors Authority, the cityattracted 39,727,022 visitors, hosted 21,615 conventions, pulled in $6.2billion in gambling revenue on the Strip, and counted over forty-onemillion visitors who came through their airport. Seventeen percent ofvisitors were international. “Las Vegas Stats & Facts,” Las VegasConvention and Visitors Authority, www.lvcva.com, accessedAugust 10, 2013, http://www.lvcva.com/stats-and-facts/. Atlantic City doesn’t come closeto equaling Vegas as a long-distance destination. In 2012, slightly morethan twenty-six million arrived by car or casino bus and 274,000 arrived

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by air. “About Us,” Do AC, www.atlanticcitynj.com, accessed August 10,2013,http://www.atlanticcitynj.com/about/stats.aspx. Mississippi Gulf Coast,now ranked tenth among major gambling destinations, brings in eightto ten million visitors a year and has an airport with a capacity for 1.2million visitors. City of Biloxi, Gaming 20/20: A City of Biloxi SpecialReport (Biloxi, MS: City Biloxi, 2012), 3, accessed August 10, 2013,http://biloxi.ms.us/PDF/Gaming2020.pdf.

[N]earby communities across the borders of neighboring states… DavidBlankenhorn, New York’s Promise: Why Sponsoring Casinos Is aRegressive Policy Unworthy of a Great State (New York: Institute forAmerican Values, 2013), see esp. chap. 7.

[T]raditional Vegas-style resort casinos catered mainly to high rollerspartial to table games… In his portrait of Las Vegas, journalist and avidblackjack gambler Marc Cooper writes of his affection for the DesertInn, a casino where table games were manned by “seasoned dealers instarched white shirts and perfectly knotted bow ties” and where therewere only “four hundred [slot] machines.” “The result”, he writes, “wasthe two most rarefied of modern Vegas commodities—lots of quiet andlots of actual gambling tables—which meant that if you were going togamble, then at least you had to sit down with other players, talk to ahuman dealer, pull out enough money to crank up your heart rate intothe target zone, and get ready to remember at least the few basic rulesof craps or blackjack.” The Last Honest Place in America: Paradise andPerdition in the New Las Vegas (New York: Nation Books, 2004), 28.

[L]ive in the region... William Eadington, “The Economics of CasinoGambling,” Journal of Economic Perspectives 13, no. 3 (Summer 1999):173–92. In the late 1990s, Eadington was predicting that “casino-stylegaming is moving…from site-specific destination resort mega-casinos tourban and suburban casinos…that serve a more localized market andthen on to various gaming opportunities in the home or neighborhood”(190). Eadington observes that “most new [casino] jurisdictions are notcapable of attracting visitors from more than 100 miles away” in“Contributions of Casino-Style Gambling to Local Economies,” Annalsof the American Academy of Social Sciences 556 (March 1998): 61.

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[F]ive-fold increase in less than two decades… International GameTechnology, IGT 2010 Annual Report (Reno, NV: International GameTechnology, 2011), 10,http://thomson.mobular.net/thomson/7/1171/4379/; InternationalGame Technology, IGT Silver Anniversary: 2005 Annual Report (Reno,NV: International Game Technology, 2006), 8, http://ccbn.mobular.net/ccbn/7/1194/1262/.

Estimated at 62 to 80 percent… Racinos getting 90 percent… NatashaDow Schull, Addiction by Design: Machine Gambling in Las Vegas(Princeton, NJ: Princeton University Press, 2012), 5, 300.Like other businesses, casinos are reducing their workforce by replac-ing workers with slot machines—a significant cost-saving for the casi-no industry. As journalist Marc Cooper observes, machines “don’t getsick, don’t take coffee breaks, don’t ask for maternity leave, don’t eventhink about unionizing, and foot for foot constitute the most profitableuse of valuable floor space.” Last Honest Place, 117.

“[S]lot machine drives the industry today”… Cited in Schull, Addictionby Design, 5.

[F]ast, continuous and repeat betting… Ibid., 54–99. Schull’s research isthe most comprehensive study of modern slots and other electronic gam-bling machines to date. She exhaustively details the features of modernslot machines, including random number generators, multiline digitizedreels, computer animated screens, the recasting of losses as potentialwins (known as near-misses), payout schedules, player tracking, and billacceptors in the machines. For a more popular description, also see GaryRivlin, “The Tug of the New-Fangled Slot Machines,” New York TimesMagazine, September 5, 2004,http://www.nytimes.com/2004/05/09/magazine/09SLOTS.html. Onproblem gamblers’ preferences for multiline play, low denominationbets, and free spins, see Australian Government ProductivityCommission, Gambling: Productivity Committee Inquiry Report, no. 50(Canberra: Australian Government Productivity Commission, 2010),vol. 1,http://www.pc.gov.au/projects/inquiry/gambling-2009/report.

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[T]ime on device… Schull, Addiction by Design, 58. “Near misses” areanother way to prolong play. For example, the machines will show allbut one of the images or numbers needed for a win, encouraging play-ers to keep on playing. See Kevin A. Harrigan, “Slot Machine StructuralCharacteristics: Creating Near Misses Using High Symbol Award Ratios,”International Journal of Mental Health and Addiction 6, no. 3 (July2008): 353–68.

[H]ighly addictive… Nicki Dowling, David Smith, and Trang Thomas,“Electronic Gaming Machines: Are They the ‘Crack-Cocaine’ ofGambling?” Addiction 100, no. 1 (2005): 33–45. According to thisreview, “there appears to be an overwhelming consensus in the litera-ture for the high ‘addictive’ potential of EGMS” (39). For an earlier andprescient analysis, see Mark Griffiths, “Gambling Technologies:Prospects for Problem Gambling,” Journal of Gambling Studies 15, no.3 (Fall 1999): 265–83.

[T]han people who engage in more traditional forms of gambling…Robert B. Breen and Mark Zimmerman, “Rapid Onset of PathologicalGambling in Machine Gamblers,” Journal of Gambling Studies 18, no.1(Spring 2002): 41–43; Robert B. Breen, “Rapid Onset of PathologicalGambling in Machine Gamblers: A Replication,” International Journalof Mental Health and Addiction 2, no. 1 (2004): 44–49, http://dspace.ucalgary.ca/bitstream/1880/47873/1/IJMHA_2004_2(1)_Breen.pdf.

[M]oderate risk for a gambling problem… Australian GovernmentProductivity Commission, Gambling, 16.

[E]xhibit problematic gambling behaviors… Schull, Addiction byDesign, 321 n60.

[B]lots out time and space... Schull, Addiction by Design, 203–7; for anextreme example of this dissociative state, see Schull’s description ofLola, 179. For a literature review of seventeen papers on the physio-logical and/or subjective arousal among machine gamblers, see JulianBaudinet and Alexander Blaszczynski, “Arousal and Gambling ModePreference: A Review of the Literature,” Journal of Gambling Studies29, no. 2 (2013): 343–58. Dr. Robert Hunter, head of the ProblemGambling Center in Las Vegas, notes how the addictive experience has

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changed: “We’re not seeing many dinosaur action gamblers who playto feel a rush. We’re seeing people who say they want to feel numb,want to blank out, want to lose track.” Cited in Cooper, Last HonestPlace, 140.

“[P]laying to extinction”… Schull, Addiction by Design, 74–75.

[Forty] to 60 percent of casino revenues… Tracy Shrans and TonySchellinck, 2003 Nova Scotia Prevalence Study: Final Report (Halifax:Nova Scotia Office of Health Promotion, 2004), iii. The study found that40 percent of gambling expenditures (losses) in Nova Scotia are esti-mated to come from 6.9 percent of adults in the province who are cur-rently scoring at any level of risk for problem gambling. Interestingly,this figure remained essentially unchanged in the 2007 Nova ScotiaPrevalence Study, even though the province had instituted reforms,including turning off all gambling machines at midnight and reducingthe speed of machines by 30 percent. Tracy Shrans and Tony Schellinck,2007 Nova Scotia Adult Gambling Prevalence Study (Halifax: NovaScotia Department of Health Promotion, 2008), 3–4,http://www.gov.ns.ca/hpp/publications/adult_gambling_report.pdf.Schull cites 30 to 60 percent of revenues from problem gamblers.Addiction by Design, 16.

[S]erious problem gambling… See an excellent summary in JudithShinogle et al., Gambling Prevalence in Maryland: A Baseline Analysis(Baltimore: Maryland Institute for Policy Analysis and Research, 2011),6–8.

[W]ho live within ten miles of a casino… John W. Welte et al., “TheRelationship of Ecological and Geographic Factors to GamblingBehavior and Pathology,” Journal of Gambling Studies 20, no. 4(Winter 2004): 419. This study controls for other variables, such as thepresence of a casino in an urban environment, permissiveness of gam-bling laws, and the fact that gambling addicts may move to get geo-graphically closer to a casino.

[L]east access had the lowest rate… Shinogle et al., GamblingPrevalence, 7.

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British study of casino gamblers… Susan Fisher, “Measuring thePrevalence of Sector-Specific Problem Gambling: A Study of CasinoPatrons,” Journal of Gambling Studies 16, no. 1 (2000): 35.

[E]xpansion after 1993… Rachel A. Volberg, When the Chips Are Down:Problem Gambling in America (New York: Century Foundation Press,2001), 62.

[T]hree to four-fold… Max Abbott, Rachel Volberg, Maria Bellringer, andGerda Reith, A Review of Research on Aspects of Problem Gambling:Final Report (Auckland: Gambling Research Centre, AucklandUniversity of Technology, 2004), 17,http://www.gla.ac.uk/media/media_34551_en.pdf. Shinogle et al.,Gambling Prevalence, 9.

[L]ess than one percent of the adult population… See, for example,repeated statements by chief gambling lobbyist, Frank J. Fahrenkopf Jr.,in letters to the New York Times. In 2008, for example, he writes: “Weunderstand that 1 percent of our potential market can be classified as‘pathological gamblers’ and we are committed to helping them.”“Gambling in New York,” letter to the editor, New York Times, May 20,2008,http://www.nytimes.com/2008/05/20/opinion/lweb20gambling.html. In 2013, Fahrenkopf writes: “[A]n in-depth, peer-reviewed study com-pleted recently by the University of Iowa reaffirms what research by theHarvard Medical School and other institutions have shown clearly overfour decades: despite the dramatic increase in casinos over the years,the rate of disordered gambling has stayed consistently at 1 percent ofthe population.” “Gambling Addiction,” letter to the editor, New YorkTimes, April 3, 2013,h t tp : / /www.ny t imes . com/2013/04/04/op in ion/gambl ing -addiction.html.

On the National Center for Responsible Gaming website, the claim isagain made as a “key research finding”: “Harvard’s estimate of approx-imately 1 percent of the adult population has been verified by inde-pendent studies and the National Academy of Sciences.” “Key ResearchFindings,” National Center for Responsible Gaming, http://www.ncrg.org/research-center/key-research-findings, accessedJune 17, 2013.

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[M]any scholars have criticized… Volberg, Chips Are Down, 5–8; Schull,Addiction by Design, 14–19; Abbott et al., Review of Research, 19.

[F]ifteen up to twenty percent... Shrans and Schellinck, 2003 Nova ScotiaPrevalence Study, xi; Australian Government Productivity Commission,Gambling, 13. This latest report from the Australian government esti-mates that among those who play weekly or more on gamingmachines, “15 per cent are problem gamblers with an additional 15 percent at ‘moderate risk.’ They account for around 75–80 percent of ‘prob-lem gamblers.’” Overview, 13, http://www.pc.gov.au/__data/assets/pdf_file/0005/95684/02-overview.pdf.

[S]pecific vulnerable subpopulations... On seniors as a vulnerable pop-ulation, see Suzi Levens et al., “Gambling Among Older, Primary CarePatients,” American Journal of Geriatric Psychiatry 13, no. 1 (January2005): 69–76. On Asian-Americans, see Michael Liao, Asian Americansand Problem Gambling, Problem Gambling Prevention TechnicalAssistance and Training Project (Los Angeles: National Asian PacificAmerican Families Against Substance Abuse),http://www.napafasa.org/pgp/PGP.Asian%20Americans%20and%20Problem%20Gambling%20Rev.11.0321.pdf.

[P]roblem gamblers hurt their families... Henry R. Lesieur, sociologistand pioneer in gambling addiction research, was one of the earlyinvestigators to look at the harms to spouses and children in a ground-breaking ethnographic study. The Chase: Career of the CompulsiveGambler (Garden City, NY: Doubleday Anchor, 1977), 54–87.

[G]ambling-related divorces... Henry R. Lesieur, “Costs and Treatmentsof Pathological Gambling,” Annals of the American Academy ofPolitical and Social Science 556, no. 153 (March 1998): 157.

[P]ervasive feelings of abandonment... Philip Darbyshire, Candice Oster,and Helen Carrig, “The Experience of Pervasive Loss: Children andYoung People Living in a Family Where Parental Gambling Is aProblem,” Journal of Gambling Studies 17, no. 1 (2001): 31–33; RuthGrant Kalischuk et al., “Problem Gambling and Its Impact on Families:A Literature Review,” International Gambling Studies, 6, no. 1 (June2006): 37–41.

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[M]ore women… According to research on gender differences amonggamblers, women prefer slot machines to other types of gambling at acasino, partly because they seek a safe, legal environment for gamblingand partly because they seek escape from personal problems and stressthrough the numbing repetition of slot play. Men are more likely toengage in all kinds of gambling and to seek the thrill of winning, LisaCavion, Carol Wong, and Masood Zangeneh, “Gambling: A SociologicalPerspective,” in In the Pursuit of Winning: Problem Gambling, Theory,Research and Treatment, ed. Masood Zangeneh, Alex Blaszczynski,and Nigel E. Turner (Toronto: Springer, 2008), 102–3.

[G]reatest level of acceptance... four out of ten in past year... nine out of10 agreed... machine gambling most popular: American GamingAssociation, 2013 State of the States, 3.

[F]uture of our business lies... Ibid., i.

[T]hree-quarters of a million young people... John W. Welte, Grace M.Barnes, Marie-Cecile O. Tidewell, and Joseph H. Hoffman, “ThePrevalence of Problem Gambling Among U.S. Adolescents and YoungAdults: Results from a National Survey,” Journal of Gambling Studies24, no. 2 (2008): 131.

For a popular report on youth gambling, see Brett Pulley, “Rite ofPassage: A Special Report; Those Seductive Snake Eyes: Tales ofGrowing Up Gambling,” New York Times, June 16, 1998, http://www.nytimes.com/1998/06/16/us/rite-passage-special-report-t h o s e - s e d u c t i v e - s n a k e - e y e s - t a l e s - g r o w i n g - u p - g a m -bling.html?pagewanted =all&src=pm.

[H]alf the sample interviewed... Dena C. Whitman, “A Day in the Nightof a Casino Worker,” in Resorting to Casinos: The Mississippi GamblingIndustry, ed. Denise von Herrman (Jackson, MS.: University ofMississippi Press, 2006), 129.

[T]ardiness, theft, embezzlement and health problems... Cited inSpectrum Gaming Group, Comprehensive Analysis: Projecting andPreparing for Potential Impact of Expanded Gaming on Commonwealthof Massachusetts, prepared for the Commonwealth of Massachusetts

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(Linwood, NJ: Spectrum Gaming Group, 2008),http://www.mass.gov/hed/docs/eohed/ma-gaming-analysis-final.pdf.

[C]hildcare, stress, and other health outcomes... Whitman, “A Day in theNight,” 123.

[P]roblems with alcohol... Ibid., 128–30.

[H]ealth risks of breathing second-hand smoke... Ronald M. Davis,“Exposure to Environmental Tobacco Smoke: Identifying andProtecting Those at Risk,” Journal of the American Medical Association280, no. 22 (1998): 1947–49. Successful class action lawsuits have beenbrought by flight attendants and other workers harmed by secondhandsmoke, but not yet by casino workers.

Paul A. Pilkington, Selena Gray, and Anna B. Gilmore, “Health Impactsof Exposure to Second Hand Smoke (SHS) amongst a Highly ExposedWorkforce: Survey of London Casino Workers,” BioMedCentral PublicHealth 7, no. 257 (September 2007): 257. This study sampled 559 casi-no workers, 39 percent nonsmokers. Ninety percent reported respira-tory problems in the previous four weeks and 71 percent reportedbeing nearly always exposed to heavy levels of secondhand smoke atwork.

Problems related to secondhand smoke apparently played a part in asignificant share of ambulance calls in Colorado’s Gilpin County, wheretwenty-six casinos are located. A recent study examining monthly dataon ambulance calls between January 2000 and December 2012 foundthat casinos accounted for 10,105 of the 16,636 ambulance calls. Thestudy further found that the incidence of ambulance calls dropped by22.8 percent when a state smoke-free law was extended to casinos, butbrought no change in calls from non-casino venues, suggesting that“important effects of secondhand smoke exposure occur acutely” topatrons and workers. The study concludes: “[E]xempting casinos fromsmoke-free laws means that more people will suffer medical emergen-cies.” Stanton A. Glantz and Erin Gibbs, “Changes in Ambulance CallsFollowing Implementation of a Smoke-Free Law and Its Extension toCasinos,” Circulation, June 25, 2013,h t t p : / / c i r c . a h a j ou r n a l s . o rg / con t en t / e a r l y / 2 0 1 3 / 0 8 / 0 2 /CIRCULATIONAHA.113. 003455.full.pdf+html.

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[F]ail to measure longer-term social costs… Robert J. Williams, JürgenRehm, and Rhys M.G. Stevens, The Social and Economic Impacts ofGambling: Final Report, prepared for Canadian Consortium forGambling Research (Canada: Canadian Consortium for GamblingResearch, 2011); Douglas M. Walker, “Problems in Quantifying theSocial Costs and Benefits of Gambling,” American Journal ofEconomics and Sociology 66, no. 3 (July 2007): 609–45; FrankAckerman and Lisa Heinzerling, Priceless: On Knowing the Price ofEverything and the Value of Nothing (New York: New Press, 2004), esp.35–40; on social costs as “externalities,” see Allan Mallach, Economicand Social Impact of Introducing Casino Gambling: A Review andAssessment of the Literature, Community Affairs Department DiscussionPaper (Philadelphia: Federal Reserve Bank of Philadelphia, 2010),19–24, h t t p : / /www .ph i l a d e l p h i a f e d . o r g / c ommun i t y - d e v e l o p -ment/publications/discussion-papers/discussion-paper_casino-gambling.pdf.

[D]iminishing social resources… Mary Tabor Griswold and Mark W.Nichols, “Social Capital and Casino Gambling in U.S. Communities,”Social Indicators Research 77, no. 3 (2006): 369.

Atlantic City as a case in point… Harriet Newburger, Anita Sands, andJohn Wackes, Atlantic City: Past as Prologue, Community AffairsDepartment Special Report (Philadelphia: Federal Reserve Bank ofPhiladelphia, 2009), vi–vii,http://www.phil.frb.org/community-development/publications/special-reports/ac-report_april-29-2009.pdf. Mallach, Economic and SocialImpact, 27.

[T]aking dollars from the community… Heather Brome to Kip Bergstrom,New England Public Policy Center, Federal Reserve Bank of Boston,“Economic Impact of Casino Development,” memorandum, September14, 2006,http://stoppredatorygambling.org/wp-content/uploads/2012/12/Federal-Reserve-Bank-of-Boston-Study-2006.pdf. This summary of secondaryeconomic impacts of casinos concludes that “casinos that cater to alocal market generally do not bring outside money into the economythrough the spending of their patrons” (4).

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[D]eclined to 142… United States General Accounting Office, Impact ofGambling: Economic Effects More Measurable Than Social Effects,Report to the Honorable Frank R. Wolf, House of Representatives,GAO/GGD-00-78 (Washington, DC: U.S. General Accounting Office,2000), 21, http://www.gao.gov/new.items/gg00078.pdf.

[N]o large supermarket in the city… Newburger, Sands, and Wackes,Atlantic City, 85.

[P]awn shops and check-cashing businesses on the Coast… RichardDavis, “Casinos, Crime, and the Costs of Criminal Justice,” in VonHerrman, Resorting to Casinos, 143.

[L]ost home values… Jim Kinney, “Realtors: Western MassachusettsCasino Will Hurt Home Values in Host Community,” The Republican,July 2, 2013,http://www.masslive.com/business-news/index.ssf/2013/07/realtors_say_casino_wouldl_hurt_home_val.html.

[P]ublic-private partnerships… On the intertwined relationshipbetween the government and the gambling industry in Philadelphia’scasino expansion, see Lisa Calvano and Lynne Andersson, “Hitting theJackpot (or Not): An Attempt to Extract Value in Philadelphia’s CasinoControversy,” Organization 17, no. 5 (September 2010): 590–93.

[C]onflict of interest… For a spirited debate on government conflict ofinterest, with implications for the U.S., see Jim Orford, “Disabling thePublic Interest: Gambling Strategies and Policies for Britain,” Addiction100, no. 9 (2005): 1219–225, as well as his critics’ responses and hisrebuttal in that same issue, “Commentaries,” 1226–38.

[P]recautionary principle… Ackerman and Heinzerling, Priceless, 224–29.

[M]oratorium of the 1999 federally funded report… National GamblingImpact Study Commission, National Gambling Impact StudyCommission: Final Report (Washington, DC: National Gambling ImpactStudy Commission, 1999),http://govinfo.library.unt.edu/ngisc/reports/fullrpt.html.

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“[B]est practices” policies... Study commissions in Australia and Canadahave adopted harm reduction policies as part of a public health effortthat looks broadly at social as well as individual health harms. Seeespecially the Australian Government Productivity Commission studies,http://www.pc.gov.au/projects/inquiry/gambling/docs/report;the Canadian provincial reports for Nova Scotia, http://dspace.ucalgary.ca/bitstream/1880/48486/1/2003Gambling_Prevalence_Study_Report.pdf; and the Canadian Consortium forGambling Research reports,http://www.ccsa.ca/2011%20CCSA%20Documents/SEIG%20FINAL%20REPORT.pdf.

[S]eriously underfunded… Alexandra Berzon, “Cash Off Table forGambling Addicts,” Wall Street Journal April 30, 2011, http://online.wsj.com/article/SB10001424052748704473104576293381628985642.html. New York provides no funding for treatment programs,but says it will assess casinos’ $500 per slot machine if voters approvea November ballot initiative for four new casinos in the state. “NewProblem Gambling Research Underscores Need for DedicatedFunding,” New York Council on Problem Gambling, http://www.nyproblemgambling.org/2011/04/04/new-problem-gam-bling-researach-underscores-need-for-dedicated-funding.

Rhode Island, Delaware and New Jersey… Josh Goodman, “RhodeIsland’s Slots Subsidy,” Governing, August 2010,http://www.governing.com/topics/economic-dev/rhode-island-slot-subsidy.html; Jonathan Starkey, “Casinos Win Bailout Funds as Bill IsOK’d,” Delaware Online, June 27, 2013, http://www.delawareonline.com/article/20130628/NEWS02/306280037/Casinos-win-bailout-funds-bill-OK-d; Kate Zernike, “Doubling Down onGambling in Atlantic City,” New York Times, July 6, 2013,http://www.nytimes.com/2013/07/07/nyregion/in-atlantic-city-dou-bling-down-on-gambling.html.

[S]aturation… Pamela M. Prah, “Does the Country Have Too ManyCasinos?” Stateline, June 26, 2013,http://www.pewstates.org/projects/stateline/headlines/does-the-coun-try-have-too-many-casinos-85899486288#.

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[G]ambling will become more regressive… Daniel B. Suits, “GamblingTaxes: Regressivity and Revenue Potential,” National Tax Journal 30,no. 1 (March 1977): 19–35; Ranjana G. Madhusudhan, “Betting onCasino Revenues: Lessons from State Experience,” National TaxJournal 49, no. 3 (September 1996): 40; Mary O Borg, Paul M. Mason,and Stephen L. Shapiro, “The Incidence of Taxes on Casino Gambling:Exploiting the Tired and Poor,” American Journal of Economics andSociology 50, no. 3 (1991): 323–32.

[O]ur first board meeting… Cited in Charles Anderer, “LifetimeAchiever,” Casino Journal, May 5, 2013,http://www.casinojournal.com/articles/print/87618-lifetime-achiever.

[F]unding $950,000 in research grants… National Center forResponsible Gaming, Connecting Innovative Research to Best Practices:2012 Annual Report (Washington, DC: National Center for ResponsibleGaming, 2013), 2, http://www.ncrg.org/sites/default/files/uploads/docs/annual_reports/2012ncrg_annual_report_final_june_rev.pdf.

[N]ot a single one… See the National Center for Responsible GamingResearch Library, http://www.ncrg.org/research-center/research-library.

[G]rowing inequality in America… The problem of growing inequalityhas been chronicled in both popular and scholarly literature in recentyears, but few, if any, of the many books, articles, and op-eds mentionthe spread of regional casinos as a feature of the institutional landscapeof inequality in America today.

[L]ow-income workers, retiree, minorities, and the disabled… Evenamong researchers who disagree about the impact of spreading casinos,there is widespread consensus that the most marginalized and econom-ically downscaled represent a disproportionate share of the regionalcasino population and contribute a disproportionate share of revenues(losses) to the state and the casino industry.

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William A. Galston and David Wasserman, “Gambling Away Our MoralCapital,” Public Interest, no. 123 (Spring 1996): 58–71 passim, raisessome of these questions. For an analysis of the bipartisan consensus ongambling, see Alan Wolfe, “The Culture War Issue That Never Was:Why the Right and Left Have Overlooked Gambling,” in Gambling:Mapping the American Moral Landscape, ed. Alan Wolfe and Erik C.Owens (Waco, TX: Baylor University Press, 2009), 373–93.

Wayne W. Parrish, “Gambling Slot-Machines That Swallow Millions,”Literary Digest (August 19, 1933) and “You Can’t Win in the Slot-Machine Racket,” Literary Digest (August 26, 1933). See also, “NewYork Mayor’s War on Slot-Machines,” Literary Digest (March 3, 1934).Ernest Havemann, “Gambling in the U.S.,” Life, June 19, 1950, reprint-ed in Gambling in America, ed. Herbert L. Marx Jr. (New York: H.W.Wilson Company, 1952). Gary Rivlin, “The Chrome-Shiny, Lights-Flashing, Wheel-Spinning, Touch-Screened, Drew-Carey-Wisecracking,Video-Playing, ‘Sound Events’-Packed, Pulse-Quickening Bandit,” NewYork Times Magazine, May 9, 2004.

[P]roblem for individuals… American Psychiatric Association, Diagnosticand Statistical Manual of Mental Disorders, 3rd ed. (Washington, DC:American Psychiatric Association, 1980), 291–93. The DSM-III, as it wasknown, placed pathological gambling in a “residual diagnostic categoryfor disorders of impulse control not classified as substance use disor-ders.” Other disorders in this category were kleptomania, pyromania,and intermittent explosive disorder. Later editions of the DSM haverevised the name, diagnostic criteria, and classification for “pathologicalgambling.” DSM-5, published in 2013, describes pathological gamblingas a behavioral disorder and places it within “Addiction and RelatedDisorders.” For a fuller discussion of the effort to revise and reclassifygambling, see Nancy Petry et al., “An Overview of and Rationale forChanges Proposed for Pathological Gambling in DSM-5,” Journal ofGambling Studies (March 2013). For a critique of the larger DSM enter-prise, see Gary Greenberg, The Book of Woe: The DSM and theUnmaking of Psychiatry (New York: Penguin Group, 2013).

[M]edicalization of gambling… Brian Castellani, PathologicalGambling: The Making of a Medical Problem (Albany: State Universityof New York Press, 2000). See also, Schull, Addiction by Design, 14–17.

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[P]olitical and public policy consequences… Barbara Dafoe Whitehead,Gambling with the Public’s Health: How Government Greed forGambling Dollars Is Spreading Addiction and Harming Americans’Health and Happiness (New York: Institute for American Values, forth-coming December 2013.) This study will examine the new science ofgambling addiction and explain how expert knowledge on gamblingaddiction has been used to advance special interests rather than thepublic interest.

About the Institute for American Values

The Institute for American Values, founded in 1987, is a private, nonparti-san organization devoted to research, publication, and public education onissues of family well-being and civil society. By providing forums for schol-arly inquiry and debate, the Institute seeks to bring fresh knowledge to bearon the challenges facing families and civil society. Through its publicationsand other educational activities, the Institute seeks to bridge the gapbetween scholarship and policy making, bringing new information to theattention of policy makers in the government, opinion makers in the media,and decision makers in the private sector.

A Casino Land Report

The Institute for American Values and its partners are conducting a series ofinvestigations called “Casino Land: America in an Age of Inequality.” Thegoal is to understand the meaning and role of casinos in American life—how they work and what they do, the values they embody and transmit,their impact on civil society, their connection to government, and their rela-tionship to the rise of American inequality. This report is a part of that series.

Institute for American Values 1841 BroadwaySuite 211New York, NY 10023 Tel: (212) 246-3942Fax: (212) [email protected] www.americanvalues.org